Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry

Pan, Emily; Guðbjartsson, Tómas; Ahlsson, Anders; Fuglsang, Simon; Geirsson, Arnar; Hansson, Emma C.; Hjortdal, Vibeke E.; Jeppsson, Anders; Järvelä, Kati; Mennander, Ari; Nozohoor, Shahab; Olsson, Christian; Wickbom, Anders; Zindovic, Igor; Gunn, Jarmo

doi:10.1016/j.jtcvs.2018.03.144

Cited by 48 publications

(41 citation statements)

References 22 publications

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“…A NORCAAD report from Pan et al recently showed freedom from reoperation rates of 98% at one year and 95% at five years [8]. Other studies have shown freedom from reoperation of 82-94% at five years [85,101,102].…”

Section: Complicationsmentioning

confidence: 99%

“…Conservative approaches are being increasingly challenged, and more extensive primary aortic repairs suggested, addressing associated and potential future problems of aortic dilatation (in the root, arch, proximal descending aorta, or entire thoracoabdominal aorta) that may both affect longterm survival and necessitate reinterventions. Reoperations after primary ATAAD repair are not uncommon in longterm survivors, or up to 25-30% [83,84], and mortality is at a respectable 10-20% for elective reoperations on the proximal aorta (25-31% on the distal aorta),but as high as 67% in acute settings [8,[83][84][85].…”

Section: Technical Aspects Of Surgical Repairmentioning

confidence: 99%

“…Thus, contemporary, sizeable, multicenter observational registries, of which NORCAAD is an example, stand out as important sources of information. This review covers different aspects of ATAAD, including epidemiology, pathophysiology, and surgical treatment, and concentrates especially on the NORCAAD studies that have been published so far [6][7][8][9][10][11][12][13]. We searched the PubMed and MEDLINE databases using the search terms "dissection," "aortic," "ascending," and "type A."…”

Section: Introductionmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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105

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Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

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Section: Complicationsmentioning

confidence: 99%

Section: Technical Aspects Of Surgical Repairmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

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105

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“…Recently, the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) published their experience with acute type A aortic dissection (ATAAD) showing that the extent of primary repair had no relationship with the reoperation rate. 1 The consortium's latest contribution from Geirsson and colleagues 2 compares the 30-day mortality and short-term survival in 153 ATAAD patients who underwent clamp-on repair (ie, standard cardiopulmonary bypass with both anastomoses done with the aortic crossclamp in place) with 981 ATAAD patients who had clamp-off/open repair (ie, circulatory arrest and an open distal anastomosis) between 2005 and 2014. The 30-day mortality and 5-year survival were 25% and 61.8% AE 4.4%, respectively, for the clamp-on group and 16% and 73% AE 1.6%, respectively, for the clamp-off cohort.…”

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confidence: 99%

Commentary: Clamp-on…clamp-off

Baciewicz

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…1 Total aortic correction and arch replacement have been a matter of debate because lifesaving surgery is the top priority during emergency; a restricted aortic correction of the ascending aorta such as a hemiarch replacement saves many patients. 2,3 The current article by Zhang and colleagues 4 presents a retrospective analysis of patients with DeBakey type I dissection operated by highly experienced surgical teams. Two different contemporaneous surgical techniques, both including an uncompromised aim to perform a 1-step doit-all arch reconstruction 5 with a distal endograft, are compared.…”

mentioning

confidence: 99%